Improving self-management of type 2 diabetes is a strategic priority for the NHS due to the increased number of people diagnosed with type 2 diabetes and the impact of devastating and costly complications that can be prevented. Good diabetes management and improving lifestyle factors such as weight and activity levels can reduce the risk of complications. However, while structured education courses can help people learn to manage diabetes, attendance rates are very low.
Clinical Commissioning Groups (CCGs) in North West London are working with three innovative digital health companies, OurPath, Oviva and Changing Health to provide digital solutions for patients with diabetes to improve self-management of diabetes.
Changing Health is on the 2017-18 DigitalHealth.London Accelerator programme, while Our Path and Oviva took part in the 2016-17 programme. The Accelerator is a partnership between London’s three AHSNs (Health Innovation Network, Imperial College Health Partners and UCLPartners), MedCity, CW+, and Guy’s and St Thomas’ Charity. The companies went through a rigorous application process with evaluation by clinicians, commissioners, and patients.
OurPath is a 12-week digital behavioural change programme aimed at preventing the onset of type 2 diabetes, along with helping people living with type 2 diabetes, through education, healthcare tracking, and health coaching via an app.
Oviva Diabetes Support is a 12-week education and behaviour change programme for people with type 2 diabetes, delivered by a diabetes specialist dietitian and supported by online learning resources and the Oviva app.
Changing Health provides behaviour change programmes for Type 2 diabetes, pre-diabetes, and weight management over 12 weeks or 12 months. The service combines personalised health coaching rooted in behavioural psychology with evidence-based digital education, focusing on sustaining long-term lifestyle change.
Approximately 3.8 million people are diagnosed with diabetes in England, 90% of whom have type 2 diabetes. The total cost to the NHS is £9.8 billion annually, much of which is spent on treating complications that can be prevented by improving lifestyle factors such as weight and activity levels, and meeting NICE recommended treatment targets for blood glucose, blood pressure and cholesterol. However, the National Diabetes Audit indicates that approximately 60% of people with type 2 diabetes do not meet these targets.
Structured education programmes can help people learn more about managing their diabetes, but despite high referral rates, attendance across the NHS is low with only around 7.4% of people newly diagnosed with type 2 diabetes attending (National Diabetes Audit). Therefore, alternative approaches are required to improve uptake of education and drive behaviour change for people with type 2 diabetes in order to improve diabetes self-management and reduce risk of complications.
In partnership with Imperial College Health Partners, the North West London Collaboration of Clinical Commissioning Groups (CCGs) offered more than 400 patients from 18 GP practices across North West London the opportunity to trial digital apps over four months.
They worked with OurPath, Oviva and Changing Health to explore provision of digital alternatives to face-to-face structured education, focusing on improving uptake of interventions and the impact on behaviour and clinical outcomes.
Eligible patients were referred to the services by their GP or practice nurse.
OurPath: patients receive a Healthbox containing wireless weighing scales and an activity tracker. Patients are also assigned a mentor who helps to set goals and give correct nutritional guidance. The patient is then joined to a group with people with similar goals.
Oviva Diabetes Support: patients receive weekly coaching from a diabetes specialist dietitian between coaching sessions, patients access evidence-based online education resources (such as videos and podcasts) and use the Oviva app to maintain a food and activity diary, which the dietitian can view and provide feedback on.
Changing Health: Patients complete a course of digital structured education and are assigned a personal lifestyle coach who helps the user set goals and individually tailor their programme. Diet, physical activity and weight are tracked using the users mobile phone or website to help the user work towards their goal. Over the next three to 12 months, coaches regularly follow up over the phone to offer feedback, advice and encouragement. Coaches can review progress in real-time using the app’s activity and weight trackers and photo food diary.
“What we have done is demonstrate the power of near real-time analytics on improving the health of populations.” Dr Tony Willis, clinical lead for diabetes for the North West London Collaboration of CCGs
83% of people in trials completed the OurPath programme and submitted information on weight loss and increased activity levels, both recommended steps to delay the progression of diabetes. At the date of analysis, of those patients that had taken part in the programme for three months, 61% had submitted a weight reading and achieved a mean weight loss of 6.7%, and increased their activity levels by 22%. After six months, 52% had achieved a mean weight loss of 8.2%. Data on the reduction of DNA rates is still being collected and analysed.
The OurPath pilot aims to replicate these successes, helping patients to better manage their disease and ultimately improve their quality of life.
Oviva Diabetes Support has demonstrated high uptake rates, and impact on weight loss, blood glucose and other clinical markers. From 1,453 referrals to date, the programme has achieved approximately 70% uptake. In terms of clinical outcomes at six months post-completion, average reduction in HbA1c (an indicator of blood glucose levels) is 13 mmol/mol and bodyweight loss is 4.5% (n=85). Initial evaluation of clinical outcomes in North West London indicates that these outcomes are replicated in this pilot, and collection of outcomes is ongoing.
Changing Health saw high levels of self-referral (60% of users recruited), which was useful for case-finding specific patient cohorts with minimal administrative burden for the GP practice. After 12 weeks of service use, active users’ Patient Activation Measures (PAM scores) increased on average by 10 points, from a mean pre-enrolment score of 56 to a mean post-participation score of 66. A one point increase in PAM score correlates to a 2% decrease in hospitalisation and a 2% increase in medication adherence.
At 12 weeks, Changing Health users reduce their HbA1c by an average of 6.8 mmol/mol (0.6% reduction), with an average reduction in body weight of 3.1% over the same period. At six months, this weight loss is sustained. 70% felt their coach helped them identify barriers to change, while 85% of users are confident Changing Health will help them achieve their goals.
It is intended that the findings of the OurPath, Oviva and Changing Health pilots will be replicated across the CCGs, and will lead to significant change in the way patients manage their condition.
The North West London Collaboration of CCGs commissioned an independent evaluation of the pilot, which was undertaken by Imperial College Health Partners
GP surgeries will follow up with their patients at 12 months. Following the success of the pilot, OurPath and Oviva are expected to be adopted by the NHS in other parts of the country, widening choice for people at risk of or diagnosed with type 2 diabetes.
Oviva and OurPath have been selected for the digital stream of the Healthier You National Diabetes Prevention programme, where they will be working across five STP footprints.
Furthermore, Oviva Diabetes Support has now been selected for the 2017 NHS Innovation Accelerator, which aims to support scaling of 11 innovations that can benefit patients, staff and the public. Oviva has also been awarded funding through the government’s Digital Health Technology Catalyst to enable further evaluation of Oviva Diabetes Support in partnership with King’s College London. Oviva Diabetes Support is now available in 18 NHS CCGs.
OurPath is going live across four 4 AHSNs over the next 12 months, and hopes to bring the programme to as wide an audience as possible across the UK.
Changing Health is now available through 16 NHS organisations across the UK with a total diabetes population of 241,675. The service will be launched in Singapore and Australia in 2018 and Saudi Arabia in 2019. The company was named in the Journal of mHealth’s Top 100 Global Healthtech Innovators in January 2018.
The pilot programme started in June 2016 and is ongoing.
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Oviva, Olivia Hind – Partnerships Lead
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Changing Health, Jon Gwillim – Marketing and Communications Director
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